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Opioid receptor agonist-antagonists are a class of drugs which have both agonistic and antagonistic effects on opioid receptors. These drugs already on the market mainly include pentazocine, butorphanol, nalbuphine, buprenorphine, dezocine and so on. Compared with pure opioid receptor agonists such as morphine and fentanyl, these drugs have strong analgesic effects, less addictive, and less side effects such as cough, itching and respiratory depression. Due to the different tendentious effects of opioid receptor agonists-antagonists among different endogenous opioid receptors (μ, κ, δ, etc.), different receptors of subtypes can exhibit different or even opposite effects in terms of affecting emotions and drug dependence. Therefore, the rational use of these drugs can effectively reduce the occurrence of adverse reactions and drug abuse caused by opioid drugs. With the deepening of research on various endogenous opioid receptor subtypes and related drugs in the academic community, opioid receptor agonists- antagonists have broad application space and prospects in improving adverse reactions to opioid drugs and enhancing patient drug compliance.
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Objective:To investigate the status of grief among maternal spouse after perinatal loss, and analyze its influencing factors, so as to provide some reference for male grief supporting strategic.Methods:Using the convenient sampling method, 180 male spouses of hospitalized women in the Department of Obstetrics from Nanjing Maternity and Child Health Care Hospital from March to October 2022 were recruited. A cross-sectional survey was conducted by the general questionnaire, the Perinatal Grief Scale, the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version, the Social Support Rating Scale, and the Simplified Coping Style Questionnaire.Results:The overall score of the Perinatal Grief Scale in male spouses of women who experienced a perinatal loss was (61.57 ± 14.14) points. The score of the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version was (121 ± 14.42) points, the score of the Social Support Rating Scale was (34.23 ± 7.21) points, and the score of the Simplified Coping Style Questionnaire was (36.08 ± 7.64) points. Multiple linear regression analysis showed that participation in fetal interaction, loss of fetal age, social support and family adaptability were the main factors affecting male grief ( P<0.05). Conclusions:The grief among male spouses of women who experienced a perinatal loss is at a low level. The clinical medical staff can refer to the influencing factors and implement effective support, such as respecting the male's father status, coordinating social support resources, and improving the family's coping ability, in order to alleviate men's grief and help them return to normal life.
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Iontophoresis is a non-invasive physical permeation technology, which has been widely applied in transdermal and transmucosal administration. Compared with other permeation technologies, iontophoresis have the advantages of high efficacy, high patient compliance and controllable delivery dose. With the development of microneedles and nano-carrier technology, the combination of iontophoresis and other penetration promotion technologies has gradually become a research hotspot. The penetration mechanism and influencing factors of iontophoresis, and the study on the combination of iontophoresis with hydrogel, microneedles or nano-carrier were reviewed in this paper.
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Objective:To study the iodine nutritional status of pregnant women in the third trimester in the Southwest of Shandong Province, analyze its impact on their cardiac electrical activity, and provide a basis for scientific supplementation of iodine during pregnancy.Methods:From January 2021 to June 2022, a cross-sectional survey was conducted using cluster random sampling method. According to the inclusion and exclusion criteria, 200 pregnant women in the third trimester were selected from 3 tertiary hospitals in three cities in the Southwest of Shandong Province, and were divided into the third trimester group ( n = 600), and 100 non-pregnant women were selected as the control group ( n = 300). The urinary iodine content was detected by arsenic-cerium catalytic spectrophotometry, and the pregnant women in the third trimester group were subdivided into iodine deficiency subgroup [G1 subgroup, median urinary iodine (MUIC) < 150 μg/L] based on the MUIC, iodine excess subgroup (G2 subgroup, MUIC≥500 μg/L) and moderate iodine subgroup (G3 subgroup, 150 μg/L≤MUIC < 500 μg/L). Chemiluminescence immunoassay was used to measure the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT 4) and free triiodothyronine (FT 3). The cardiac electrical indexes were detected by a 12-lead surface electrocardiogram (ECG) machine. Results:There was no statistically significant difference in urinary iodine levels between pregnant women in the third trimester group and non-pregnant women in the control group among the 3 tertiary hospitals in the Southwest of Shandong Province ( H = 3.63, 3.27, P > 0.05). In the third trimester group, the proportion of pregnant women in the G1, G2 and G3 subgroups was 27.67% (166/600), 6.83% (41/600) and 65.50% (393/600), respectively. There was a statistically significant difference in urinary iodine levels between the subgroups and the control group ( H = 11.56, P < 0.001). The serum FT 3 and FT 4 levels in the G2 subgroup were lower than those in the G1 and G3 subgroups ( P < 0.001), but there was no statistically significant difference in serum TSH levels among the three subgroups ( P > 0.05). The normal rates of ECG in the G1, G2, G3 subgroups, and the control group were 38.55% (64/166), 41.46% (17/41), 92.37% (363/393), and 95.33% (286/300), respectively. The difference between the groups were statistically significant (χ 2 = 461.25, P < 0.001), the normal rate of ECG in the G1 and G2 subgroups was lower than that in the control group ( P < 0.001). Short P-R intervals and ST-T changes were the most common abnormal ECG in the third trimester group. Conclusions:The incidence of iodine deficiency, iodine excess, and other abnormal iodine nutritional status in pregnant women in the third trimester of the Southwest of Shandong Province is relatively high. Short P-R intervals, ST-T changes, and other arrhythmia caused by this are more common. It is necessary to strengthen monitoring of iodine nutritional status and ECG during pregnancy, and adjust intervention strategies such as iodine supplementation in a timely manner.
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Objective:To develop an accurate, specific and rapid and non-destructive technique for the identification of Candida auris and its relatives without destroying the cell wall. Methods:The study was conducted in Beijing Institute of Radiation Medicine in 2021. Surface-enhanced Raman spectroscopy (SERS) substrates were prepared by sodium citrate reduction. Through SERS, the collected SERS fingerprint spectra were analyzed by orthogonal partial least-squares-discrimination analysis (OPLS-DA) using SIMCA 14.1 (Umetrics, Sweden). Four strains of Candida auris, 4 strains of Candida heamulonii, 3 strains of Candida pseudohaemulonii and 4 strains of Candida duobushaemulonii were effectively identified and distinguished. Results:Within the 95% confidence interval, the sample analysis results presented an oval. The four Candida species detected in this study could be well separated. R2X(cum)=0.629, R2Y(cum)=0.947, Q2(cum)=0.915. R2X, R2Y and Q2 all>0.5 and closed to 1, suggesting that the model in this study was well established, and had good prediction ability. The results of the 10-fold-cross validation showed that the accuracy of both the model training data and test data are 100%, indicating that the model established in this research had good classification capabilities. Conclusions:This research has developed a new technique that can identify Candida auris and its relatives in a highly accuracy, specific and rapid way without destroying the cell wall. Being cost-effective and easy to operate, this technique has great potential to be applied in clinical fungal testing.
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Objective:To explore the evaluation dimensions and indicators of research hospital, provide empirical evidence for the construction of research hospital.Methods:Non-probability sampling was adopted, physicians from 9 hospitals in Shanghai that have a National Clinical Medical Research Center or Shanghai Clinical Medical Research Center were invited as survey participants. The physician participants were divided into senior and junior groups. For senior group, a questionnaire including 5 dimensions and 21 indicators was provided. The survey participants were consulted to determine whether the indicators can be used to measure this dimension, and also invited to propose additional dimensions and indicators for improvement.For junior group, two open questions were proposed to explore their needs of support in both clinical service and research.Results:Based on suggestions from the research participants, the research team, and other expert consultant, this article tried to propose 5 dimensions and 21 indicators for evaluating research hospitals. Among them, 11 were indicators compiled by the research team based on the literature review and agreed by more than 2/3 of senior physicians surveyed, while others were proposed based on the survey results. The research team planned to use the entropy method to determine the weights of different indicators, thus, the participants were not required to make judgments on the weights of dimensions and indicators.Conclusions:The evaluation of research hospitals has not yet formed a systematic consensus. Through the exploration and establishment of evaluation dimensions and indicators, identify hospitals that are closer to the development goals of research hospitals can provide a basis for future next-step practices.
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Objective:To investigate and analyze the current status and influencing factors of loss to follow-up among moderate to severe chronic periodontitis patients with long-term periodontal therapy.Methods:A total of 196 patients with moderate to severe chronic periodontitis receiving treatment from January 2016 to June 2017 were recruited by convenient sampling. A self-developed Clinical and Demographic Questionnaire, Self-efficacy Scale for Self-care (SESS), Dental Fear Scale (DFS) were used to obtain data at baseline. The outcome of loss to follow up within 20 months after the initial treatment of periodontitis was further recorded. Multivariate Logistic regression analysis was conducted to identify the influencing factors of loss to follow-up in patients with long-term periodontal therapy.Results:112 of 196 patients were lost during follow-up period(observation group), and 84 patients were lost during follow-up period (control group). Compared with control group, there were significant differences in age [(47.8±9.8) years vs. (42.2±11.2)years, t value was 6.672], education level[≤college: 23.2% (26/112) vs.13.1%(11/84), χ2 value was 5.033], disease severity [moderate:53.6% (60/112) vs.34.5% (29/54), χ2 value was 9.027], the proportion of patients undergoing periodontal surgery [4.5% (5/112) vs. 23.8% (20/84) χ2 value was 8.264], the low-level of self-efficacy for self-care [53.6% (60/112) vs. 6.0% (5/84), χ2 value was 18.992] and the score of SESS (52.6±8.2 vs. 62.9±7.1), t value was 5.996] in observation group ( P<0.05) . Multivariate logistic regression analysis showed that the risk factors of loss to follow-up in chronic periodontitis patients with long-term periodontal therapy included age increase ( OR=1.043, 95% CI 1.013-1.085, P=0.007), moderate disease severity ( OR=4.894, 95% CI 2.291-10.588, P<0.01), non-surgical treatment ( OR=11.356, 95% CI 2.236-27.483, P=0.004), low-level self-efficacy for oral self-care ( OR= 31.884, 95% CI 20.812-56.173, P<0.01). Conclusions:Age, severity of periodontitis, the way of periodontal treatment and the level of self-efficacy for oral self-care are influencing factors of loss to follow-up in chronic periodontitis patients with long-term periodontal therapy.
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Objective:To explore the effect of independent E purchasing skill training on social function rehabilitation of long-term inpatients with schizophrenia.Methods:A total of 42 inpatients with schizophrenia was divided into control group (22 cases) and experimental group (20 cases) by the random number table method. The control group was treated with traditional routine nursing and drug therapy, while the experimental group was treated with independent E purchasing skills training and drug therapy. The curative effect was evaluated by the Positive and Negative Syndrome Scale (PANSS), General Self-Efficacy Scale (GSES), Scale of Social function in Psychosis Inpatients (SSPI) before the intervention and at the end of the 12th week of intervention.Results:After 12 weeks intervention, the total score of PANSS in the experimental group was (44.60 ± 5.68), of which the positive symptom was (8.50 ± 1.47), the negative symptom was (11.90 ± 2.79) and the general psychopathology was (24.05 ± 3.02). In the control group, the scores of each type were (58.95 ± 9.62), (10.36 ± 3.67), (18.00 ± 4.67) and (30.59 ± 5.13). The difference between the two groups were statistically significant ( t values were -5.810- - 2.119, P<0.05). After 12 weeks intervention, the score of GSES in experimental group was (3.45 ± 0.48) and in control group (2.29± 0.69), the difference was statistically significant ( t value was 6.256, P<0.05). After 12 weeks intervention, the total score of SSPI was (38.90 ± 2.72), the score of the subjects' ability of daily living was (10.95 ± 1.19), the mobility and communication (15.45 ± 1.57), social activity skills (12.00 ± 1.34) in the experimental group. The scores of each type were (25.32 ± 6.36), (8.36 ± 1.59), (9.95 ± 2.75) and (7.00 ± 2.56) in the control group, the differences were statistically significant ( t values were 5.918-8.513, P<0.05). Conclusions:Independent E-purchasing skills training can improve the mental symptoms of long-term inpatients with schizophrenia, improve the self-efficacy and social function of inpatients with schizophrenia, and promote the rehabilitation of social function.
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Objective:To discuss hypertension situations of 40-79 years old residents with different glucose metabolic status in Guiyang urban area under the new hypertension diagnostic criteria proposed by American College of Cardiology/American Heart Association (ACC/AHA) in 2017 and provide a clue for diagnostic criteria and treatment strategy of hypertension.Methods:10 140 residents in 40-79 years old in Risk Evaluation of cAncers in Chinese diabeTic Individuals: a IONgitudinal (REACTION) Study Research Guiyang Sub-center were conducted retrospective analysis. According to medical history of diabetes and oral glucose tolerance test results, these residents were divided into normal glucose group, impaired fasting glucose(IFG) group, impaired glucose tolerance (IGT) group, IFG+ IGF group, previous diagnostic diabetes group and newly diagnosed diabetes group. Hypertension situation of residents with different glucose metabolic status under the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), and Hypertension Guide of ACC/AHA in 2017 were calculated.Results:Under JNC 7 criteria, hypertension′s standardized prevalence rate of normal blood glucose people, prediabetes patients, and diabetes patients in 40-79 years old respectively reached 8.19%, 9.57%, and 8.19%. Under ACC/AHA 2017 criteria, hypertension′s standardized prevalence rate respectively reached 20.27%, 16.35%, and 11.59%. By contrast, the most obvious increase of hypertension′s prevalence rate was in the normal blood glucose group and IGT group. Newly increased hypertension patients reached 1 739. Among them, 25.8% required antihypertensive drugs for treatment. According to the 6th demographic census data of Guizhou Province in 2010, it was estimated that newly increased hypertensive patients aged 40-79 years in prediabetes patients reached 123 000, among them, 20 000 required treatment. Newly increased hypertensive patients aged 40-79 years in diabetes patients reached 68 000, among them, 21 000 required treatment.Conclusions:ACC/AHA Hypertension Guide in 2017 will obviously increase hypertension′s prevalence rate of people with different glucose metabolic status in 40-49 years old. The treatment ratio of hypertension groups with diabetes and prediabetes is considerably high. As a result, social medical burdens is going to aggravate.
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This study was designed to evaluate ERK5 expression in lung cancer and malignant melanoma progression and to ascertain the involvement of ERK5 signaling in lung cancer and melanoma. We show that ERK5 expression is abundant in human lung cancer samples, and elevated ERK5 expression in lung cancer was linked to the acquisition of increased metastatic and invasive potential. Importantly, we observed a significant correlation between ERK5 activity and FAK expression and its phosphorylation at the Ser
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Animals , Humans , Mice , A549 Cells , Cell Movement , Epithelial-Mesenchymal Transition/genetics , Focal Adhesion Kinase 1/metabolism , Lung Neoplasms/pathology , MAP Kinase Signaling System , Mitogen-Activated Protein Kinase 7/metabolism , Neoplasm Invasiveness , Neoplasm Metastasis , Neoplasm Proteins/metabolismABSTRACT
Objective To evaluate the application way and value of autologous succus entericus reinfusion in neonatal enterostomy.Methods Clinical data from 109 neonatal patients receiving enterostomy in Children's Hospital of Nanjing Medical University from January 2010 to December 2017 were retrospectively analyzed.The neonatal patients were divided into two groups according to whether succus entericus reinfusion conducted as succus entericus reinfusion group (63 neonatal patients) and control group (46 neonatal patients).The 90-day weight gain of the neonatal patients,age of the second stage enterostomy closure,cessation of intravenous infusion time after operation and the rate of re-admission before the second stage enterostomy closure were collected.Results The distance between enterostomy mouth and the Treitz ligament was 80-120 cm in all the children patients,and there was no significant difference between the two groups (P=0.42).The succus entericus reinfusion group was superior to the control group in the weight gain of 90 days after birth (single lumen group vs.single lumen control group:[1.97±0.55] vs.[1.50±0.57] kg,P=0.017;double lumens group vs.double lumenscontrol group:[1.82±0.49] vs.[1.48±0.65] kg,P=0.013),age of the second stage enterostomy closure (single lumen group vs.single lumen control group:[115.76± 15.85] vs.[117.40 ± 11.06] d,P =0.025;double lumens group vs.double lumens control group:[115.48± 14.33] vs.[126.03±8.85] d,P=0.001),cessation of intravenous infusion time after operation (single lumen group vs.single lumen control group:[14.24±3.30] vs.[16.40±2.74] d,P=0.046;double lumens group vs.double lumens control group:[15.07±3.65] vs.[18.71±3.63] d,P<0.01),and the rate of re-admission before the second stage enterostomy closure (single lumen group vs.single lumen control group:9.5% [2/21] vs.20% [3/15],P=0.337;double lumens group vs.double lumens control group:7.1% [3/42] vs.25.8% [8/31],P =0.028).Conclusion Autologous succus entericus reinfusion can improve the absorption of nutrients after the operation of small intestinal stoma,improve the function of the distal enteral tube,and create conditions for the early recovery of intestinal continuity.
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OBJECTIVE: To explore the methods and ideas for clinical pharmacists to optimize anti-infective treatment programs in obese patients with pulmonary infection. METHODS: The clinical pharmacist optimized the anti-infection regimen of an obese patient with post-stroke pulmonary infection (BMI=34.602 kg/m2) admitted to our hospital, and adjusted the dose adjustment and drug replacement of piperacillin tazobactam in the obese patient. And the selection of methicillin-resistant Staphylococcus aureus (MRSA) drugs and dose determination were proposed. RESULTS: According to the patient’s body weight and guidelines, the dose of piperacillin tazobactam was adjusted from 4.5 g, q12 h to 4.5 g, q6 h; the antibiotic was changed to moxifloxacin due to pathogenic changes, the dose was 0.4 g, qd, no need to increase When diagnosed as pneumonia caused by MRSA infection, linezolid was used instead of vancomycin for infection treatment in obese patients, and the dose was determined to be 600 mg, q12 h. The physician adopted the above recommendations. After treatment, the patient’s temperature decreased, cough and sputum eased, and the laboratory indicators returned to normal and discharged smoothly. CONCLUSION: Clinical pharmacists can participate in the drug treatment of special obese patients by exerting their own professional advantages: by adjusting the type, dose and frequency of antibacterial drugs, patients can obtain individualized treatment, improve the safety and effectiveness of patients’ medication, and finally obtain satisfactory results.
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Objective To evaluate the effect of positive end-expiratory pressure (PEEP) ventilation guided by esophageal pressure (Pes) on pulmonary function after laparoscopic surgery in elderly patients.Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged ≥ 65 yr,with body mass index of 16-28 kg/m2,scheduled for elective laparoscopic radical resection of colorectal cancer,were divided into 2 groups (n =30 each) using a random number table method:PEEP group (group P) and Pes-guided PEEP group (group PP).After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.The fresh gas flow of oxygen was set at 2 ml/L,tidal volume (VT) was 8 ml/kg,inspiratory/expiratory ratio was 1.0:(1.5-2.0),fraction of inspired oxygenwas 60%,the respiratory rate was adjusted,and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.PEEP was set at 5 cmH2O in group P.PEEP was set according to Pes to maintain 5 mmHg ≤ transpulmonary end-expiratory pressure ≤ 10 mmHg in group PP.Forced expiratory volume first second,forced vital capacity,and maximum ventilatory volume were determined after admission to the operating room and at 1,3 and 5 days after operation.Blood samples were collected from the radial artery for blood gas analysis,PaO2 and PaCO2 were recorded,and oxygenation index (PaO2/FiO2) was calculated.Clinical Pulmonary Infection Score was assessed.The development of postoperative pulmonary complications such as pulmonary atelectasis,pneumothorax,respiratory failure,aspiration pneumonia,respiratory infections,pleural effusion and bronchial asthma was recorded.Results Compared with group P,forced expiratory volume first second,forced vital capacity,and maximum ventilatory volume,PaO2 and PaO2/FiO2 were significantly increased at 1,3 and 5 days after operation,and the Clinical Pulmonary Infection Score and incidence of pulmonary atelectasis and respiratory infections were decreased in group PP (P<0.05).Conclusion Pes-guided PEEP can improve pulmonary function after laparoscopic surgery and decrease pulmonary complications in elderly patients.
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Objective To investigate characteristics of deceleration capacity (DC) and Tp-e/QT value in different age groups of patients with diabetic autonomic neuropathy, and to analyze their influencing factors. Methods A total of 487 subjects were enrolled in this study, and divided into three groups:patients with diabetic autonomic neuropathy (DM+CAN group,n=287), normal glucose tolerance patients with diabetic autonomic neuropathy (CAN group,n=130) and healthy controls (NC group,n=150).Then the DM+CAN group were further divided into three subgroups according to age tertiles:the lowest tertile group (35.0~47.2 years old,n=91),the middle tertile group (47.3~59.6 years old,n=116)and the highest tertile group (59.7~72.0 years old,n=80).All subjects were underwent 24-hour dynamic electrocardiogram recordings.DC and Tp-e/QT values were calculated,and then the correlation between DC and Tp-e/QT with other indicators was analyzed. Results The levels of WC,SBP,BMI,FPG,HbA1c,FIns and HOMA-IR were higher in DM+CAN group than in CAN group and in NC group (P0.05).DC increased [(2.90±0.47) vs (4.22±0.41) vs (4.97±0.35) ms],and the Tp-e/QT decreased [(0.23±0.05) vs (0.18±0.03) vs (0.12±0.02)] from the highest tertile group to the lowest tertile group,(P<0.05 or P<0.01),and the pairwise comparisons were statistically significant (P<0.05 or P<0.01).Multiple stepwise regression analysis showed that age,DM duration,WC,FPG,HbA1c,complicated with hypertension and coronary heart disease (CHD) were risk factors for DC and Tp-e/QT values (P<0.05). Conclusion Together with the increased age,DC level is reduced and Tp-e/QT value increased in patients with diabetic autonomic neuropathy.Dynamic electrocardiogram should be considered in patients with advanced age,long DM duration,high level of WC,FPG,HbA1c,and complicated with hypertension and CHD,in order to prevent the occurrence of cardiovascular events effectively.
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Objective To study the therapeutic effect of rheum(Chinese herbal medicine) preparation made by using ultrasonic technique on pro-inflammatory cytokines and sepsis in rats.In order to offer novel measure for the treatment of critically ill patients.Methods Firstly, rheum sterile solution was prepared through ultrasonic technique.Secondly, fifty healthy male SD rats were randomly(random number) divided to CLP group and rheum group.Moderate degree of sepsis model was established by using cecal ligation and puncture(CLP).Rats in group rheum received the liquid rheumpreparation via intragastric administration, while rats in group CLP received saline instead.The 7-day survival rate was recorded and was compared between two groups.In addition, another fifty-four rats were randomly(random number) divided to sham group, CLP group and rheum group(n=18 in each group).CLP was performed to induce sepsis in CLP group and rheum group.Then rats in rheum group received rheum sterile solution via intragastric administration, while rats in CLP group received saline instead.At 12 hours, 24 hours and 48 hours after modeling, six rats in each group were randomly sacrificed.Serum TNF-α and HMGB1 levels were detected by ELISA method.Levels of RAGE, HMGB1 and NF-κB P65 in small intestine were detected by Western Blot.Results Level of anthraquinones extracted from rheum by ultrasonic technique was higher than that by conwentional decoction method.The 7-day survival rate of rats in rheum group(76%) was higher than that in CLP group(48%)(P0.05).At 24 hours and 48 hours after modeling, serum HMGB1 levels were significantly lower in rheum group than those in CLP group(P<0.05).Compared with sham group, protein levels of HMGB1, RAGE and NF-κB in small intestine were elevated in CLP group and rheum group at 48 hours after modeling(P<0.01), while protein levels of above biomarker were higher in CLP group than those in rheum group(P<0.05).Conclusions Rheum sterile solution could down-regulate the level of pro-inflammatory cytokines, modulate the inflammatory response, and improve the survival rate in rats with sepsis.
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Objective To detect levels of C?X?C chemokine receptor type 5 (CXCR5) and inducible costimulator(ICOS)in blister fluid of patients with bullous pemphigoid(BP), and to explore their significance in the pathogenesis of BP. Methods Blister fluid samples were collected from 15 patients with BP(experimental group)and 15 patients with second?degree burns(control group). Enzyme?linked immunosorbent assay(ELISA)was performed to detect the levels of CXCR5 and ICOS in the 2 groups. Results The level of CXCR5 was significantly higher in the experimental group than in the control group(219 ± 145.31 vs. 147 ± 23.83 ng/L, t=4.577, P 0.05). Conclusion The expression of CXCR5 may be associated with the occurrence of BP, but further researches are needed to determine the relationship between ICOS and the occurrence of BP.
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Objective To investigate the diagnosis,surgical therapy of congenital pyloric atresia in neonates.Method Six congenital pyloric atresia neonates in Children's Hospital of Nanjing Medical University were admitted,including 4 cases of complete atresia with pyloric diaphragm,1 case of incomplete atrsia with a foraminula in the pyloric diaphragm and 1 case of pyloric atresia with solid segment.Three cases were associated with epidermolysis bullosa,multiple intestinal atresia and annular pancreas respectively.Results The main presenting symptoms were nonbilious vomiting,and 5 cases of abdominal X-ray plain film showed a large single gastric air-bubble and no gas distally.Ultrasonography and upper gastrointestinal radiography showed complete gastric outlet obstruction,and in 1 case postbulbar obstruction.Neonates with pyloric diaphragm underwent diaphragm excision and pyloroplasty,and that with solid segment did an extended pyloroplasty.The one complicating intestinal atresia was abandened surgery.Five cases were followed up,and doing well with complete recovery.Conclusion Abdominal X-ray plain film,Doppler ultrasonography and upper gastrointestinal radiography help establish the diagnosis of neonatal congenital pyloric atresia.Surgery is the therapy of choice and the prognosis is very good.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of bowel plication combined with early enteral nutrition (EEN) in the enhanced recovery after surgery(ERAS) of jejunal atresia (JA) neonates.</p><p><b>METHODS</b>Between January 2005 and January 2014, 58 neonates with JA underwent surgical treatment in Children's Hospital of Nanjing Medical University. Their clinical data, including operation procedures, ages, birth weight, concomitant diseases, age at surgery, hospital stay, total parenteral nutrition (TPN), postoperative intestinal function recovery (the time to the first oral feeding and the time to oral feeding volume reaching 150 ml·kg·d), complications and reoperation, were retrospectively analyzed.</p><p><b>RESULTS</b>According to the surgical procedures, the 58 neonates were divided into three groups: control group(18 cases, undergoing atretic segments resection and primary anastomosis), bowel plication group(19 cases, undergoing bowel plication after atretic segments resection and primary anastomosis) and bowel plication combined with EEN group (21 cases, undergoing bowel plication combined with EEN). No significant differences of ages, birth weight, age at operation, and concomitant diseases were found among 3 groups (all P>0.05). The time of hospital stay, the time to the first oral feeding, the time to oral feeding volume reaching 150 ml·kg·d, and the time of TPN in bowel plication group were significantly shorter than those of control group [(19.3±4.4) d vs. (22.7±3.1) d, t=2.696, P=0.011; (9.8±3.3) d vs. (12.5±3.0) d, t=2.630, P=0.013; (18.5±4.1) d vs. (21.5±2.5) d, t=2.726, P=0.011; (13.1±2.9) d vs. (15.0±2.3) d, t=2.219, P=0.033]. However, above parameters of bowel plication combined with EEN group were significantly shorter than those of bowel plication group [(15.3±3.5) d vs. (19.3±4.4), t=4.120, P=0.003; (7.7±2.2) d vs. (9.8±3.3) d, t=2.428, P=0.020; (14.8±2.5) d vs. (18.5±4.1) d, t=3.752, P=0.001; (9.5±3.0) vs. (13.1±2.9) d, t=4.370, P=0.000].</p><p><b>CONCLUSION</b>The bowel plication combined with EEN contributes to the early use of intestinal function, shorten the time to the first oral feeding, and reduces the use of TPN, which can improve the recovery of jejunal atresia neonates.</p>
Subject(s)
Humans , Infant, Newborn , Anastomosis, Surgical , Comparative Effectiveness Research , Defecation , Digestive System Surgical Procedures , Methods , Enteral Nutrition , Methods , Intestinal Atresia , Rehabilitation , General Surgery , Jejunum , Congenital Abnormalities , General Surgery , Length of Stay , Parenteral Nutrition, Total , Postoperative Period , Retrospective StudiesABSTRACT
Objective To investigate the different expressions of pathological tissue and serum microRNAs (miRNAs)in Hirschsprung disease(HSCR). Methods Pathological colon tissues and serum samples were obtained from 52 confirmed HSCR cases respectively by surgery and pathology and from 52 matched controls,respectively. An initial screening of the tissues and serum microRNA expression were performed through TaqMan Low Density Array. The candidate tissue and serum miRNAs were validated by quantitative real - time - PCR in the 20 paired array samples and extra 32 paired samples after the integration of the screening result. The bioinformatical software online including miR-base,Target Scan,PicTar and MiRanda were used to predict the target mRNA of the consistent microRNAs in the tis-sues and the serum. Results Compared with the controls,47 microRNAs were differently expressed in HSCR tissues, including 17 up - regulated miRNAs and 30 down - regulated miRNAs;32 upregulated miRNAs were also detected to be differently expressed in the HSCR serum. Among these microRNAs,miR - 218 - 1 and miR - 885 - 5p were identi-fied to have a consistent significant different expression in both tissues and the serum,which were validated as high -expressed in microarray samples and expanded 32 paired samples(miR - 218 - 1:tissue array 0. 017 58 ± 0. 002 29 vs 0. 003 37 ± 0. 000 50,P ﹤ 0. 001;tissue expanded expression 0. 013 53 ± 0. 001 74 vs 0. 004 43 ± 0. 000 60,P ﹤0. 001. miR - 885 - 5p:tissue array 0. 000 30 ± 0. 000 11 vs 0. 000 04 ± 0. 0000 08,P = 0. 027 6;tissue expanded ex-pression 0. 004 59 ± 0. 000 16 vs 0. 000 04 ± 0. 000 01,P = 0. 014 5. miR - 218 - 1:serum array 0. 769 60 ± 0. 285 50 vs 0. 045 14 ± 0. 015 07,P = 0. 015 5;serum expanded expression 1. 151 00 ± 0. 430 00 vs 0. 023 07 ± 0. 003 81,P =0. 008 7. miR -885 -5p:serum array 1. 595 00 ±0. 441 70 vs 0. 169 40 ±0. 034 46,P =0. 001 2;serum expanded expres-sion 1. 689 00 ±0. 453 00 vs 0. 146 10 ± 0. 031 24,P = 0. 001 2). Specifically,the target genes of these 2 microRNAs were RET,PLAG1 and NeuroD1,which had been reported to be directly related to HSCR. Conclusions Significantly dif-ferential expressed miRNAs exist in the pathological tissue and the serum of HSCR. MiR - 218 - 1 and miR - 885 - 5p, which showing consistent differential expression,may be involved in the pathogenesis of HSCR.
ABSTRACT
Objective To evaluate the effect of positive end-expiratory pressure (PEEP) on intraoperative pulmonary function in the patients undergoing urological retroperitoneal laparoscopic surgery in the mode of protective ventilation.Methods Forty patients of both sexes,aged 30-64 yr,with body mass index of 16-29 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective retroperitoneal laparoscopic ureterolithotorny,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and PEEP group (group P).After induction of general anesthesia,the patients were endotracheally intubated.Intermittent positive pressure ventilation (tidal volume [Vr] 6 ml/kg,respiratory rate [RR] 12 breaths/min,inspiratory/expiratory ratio [I:E] 1:2,fraction of inspired oxygen 50%) was performed from the end of intubation until the onset of pneumoperitoneum.After the onset of pneumoperitoneum,the patients were ventilated (VT 6 ml/kg,RR 22 breaths/min,I:E 1.0:1.5),and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in group C.After the onset of pneumoperitoneum,the patients were ventilated (VT 6 ml/kg,RR 22 breaths/min,I:E1.0:1.5,PEEP 5 cmH2O),and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in group P.At 5 min before pneumoperitoneum (T1),at 10,30 and 60 min of pneumoperitoneum (T2-4),immediately after the end of pneumoperitoneum (T5),and at 5 min before extubation (T6),arterial blood samples were collected for blood gas analysis.Peak airway pressure and mean airway pressure were also recorded.Dynamic lung compliance,oxygenation index,respiratory index,dead space fraction and alveolararterial oxygen gradient were calculated.Results Compared with group C,mean airway pressure was significantly higher at T2-4,oxygenation index was significantly higher at T3,alveolar-arterial oxygen gradient difference was significantly lower at T3 and T6,and respiratory index was significantly lower at T6 (P<0.05),and no significant change was found in the peak airway pressure,dynamic lung compliance and dead space fraction at each time point in group P (P>0.05).Conclusion PEEP (5 cmH2O) can improve the intraoperative pulmonary function in the patients undergoing urological retroperitoneal laparoscopic surgery in the mode of protective ventilation.